Quick Tips and Reminders from BCBSIL Provider Network Consultants
Our Provider Network Consultants (PNCs) serve as the liaison between Blue Cross and Blue Shield of Illinois (BCBSIL) and the independently contracted providers who work with us, developing and maintaining working relationships with providers. Our PNCs host a monthly “Hot Topics” webinar to connect with you in a convenient online forum. Based on feedback from providers, our PNCs would like to share some quick tips and reminders for you and your staff.
New Groups/Providers: Prior to billing for services you are rendering to our members, please ensure your contract has been successfully completed and you have received network effective dates. If you have already completed a Provider Onboarding Form, you can check the status of your application by entering the case number you received in your confirmation email in our Case Status Checker.
- All providers who require credentialing must complete an Illinois Council for Affordable Quality Healthcare (CAQH®) File. Make sure your CAQH is up-to-date prior to submitting your application. This will lessen outstanding billing issues. If your CAQH profile is not complete, your onboarding form will be rejected/returned to the submitter. To check the status of your credentialing process, enter your National Provider Identifier (NPI) or state license number in our Credentialing Status Checker.
- Once your contract has been completed, you will receive notification from our Network Operations team. If claims are received prior to the network effective dates and contract completion, your claims may deny or reject.
Updating Your Group/Provider File: We understand change is continual for contracted providers. To update demographic information – such as adding or removing an address, changing your Tax ID or NPI, removing a provider from the Group, or changing your Legal Name – you may use the online Demographic Change Form. If you have completed a Demographic Change Form, you can check the status of your application by entering the case number you received in your confirmation email in our Case Status Checker.
Direct Deposit: To ensure your reimbursements are properly received, we encourage providers to enroll for Electronic Funds Transfer (EFT).
Provider Claim Summary: The Electronic Remittance Advice (ERA) is equivalent to an Explanation of Benefits. The Explanation of Benefits provides detailed information concerning the medical insurance claim and the summary of charges.
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CAQH is an independent third party not-for-profit collaborative alliance of the nation’s leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. CAQH is solely responsible for its products and services, including the ProView database.